Prevalence and Population-Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study
Peter Burney, Jaymini Patel, Cosetta Minelli, Louisa Gnatiuc, André F.S. Amaral, Ali Kocabaş, Hamid Hacene Cherkaski, Amund Gulsvik, Rune Nielsen, Eric Bateman, Anamika Jithoo, Kevin Mortimer, Talant M. Sooronbaev, Hervé Lawin, Chakib Nejjari, M. Elbiaze, Karima El Rhazi, Jin-Ping Zheng, Pixin Ran, Tobias Welte, Daniel Obaseki, Gregory E. Erhabor, Asma Elsony, Nada Bakri Osman, Rana Ahmed, Ewa Nizankowska-Mogilnicka, Filip Mejza, David M. Mannino, Cristina Bárbara, Emiel F.�M. Wouters, Luisito F. Idolor, Li‐Cher Loh, Abdul Rashid, Sanjay Juvekar, Thorarinn Gislason, M. Al Ghobain, Michael Studnicka, Imed Harrabi, Meriam Denguezli, Parvaiz A Koul, Christine Jenkins, Guy B. Marks, Rain Jögi, Hasan Hafizi, Christer Janson, Wan C. Tan, Althea Aquart-Stewart, Bertrand Mbatchou, Asaad Ahmed Nafees, Kirthi Gunasekera, Terry Seemungal, P A Mahesh, Paul Enright, William M. Vollmer, Marta Blangiardo, Fadlalla G. Elfadaly, A. Sonia Buist
Abstract
Abstract Rationale The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD). Objectives To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged ≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV1-to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites. From these relative risks and the prevalence of risk factors, we estimated local population attributable risks. Measurements and Main Results The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.